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目的评价P型空肠袢食管空肠Roux-en-Y吻合术和改良空肠间置代胃术这两种消化道重建方式的疗效。方法选取2012年3月至2013年12月收治的64例胃癌患者,随机分为试验组和对照组,每组32例。对照组患者采用P型空肠袢食管空肠Roux-en-Y吻合术,试验组患者采用改良空肠间置代胃术。评价指标为消化道重建时间、术后进食频率、术后6个月患者营养指标改变(血红蛋白、白蛋白、总蛋白及体重下降幅度)及并发症发生率,并对两组患者术后疗效进行比较。结果患者年龄、病程、病变部位等临床一般特征差异无统计学意义(P>0.05)。试验组和对照组患者的消化道重建时间分别为(38.12±12.32)d和(47.92±11.36)d,术后进食频率分别为8次/d和2次/d,体重下降幅度分别为(10.36±3.31)d和(13.62±5.23)d,差异均有统计学意义(均P<0.05)。试验组患者术前和术后的营养指标血红蛋白分别为(26.4±8.4)g/L和(44.3±13.3)g/L,白蛋白分别为(78.6±26.6)g/L和(122.7±39.7)g/L,总蛋白分别为(47.2±15.2)g/L和(69.5±21.5)g/L,差异均有统计学意义(均P<0.05)。对照组患者术前和术后血红蛋白分别为(79.4±25.4)g/L和(90.1±29.1)g/L,白蛋白分别为(25.8±8.8)g/L和(29.6±9.6)g/L,总蛋白含量分别为(46.9±21.9)g/L和(51.2±16.2)g/L,差异均无统计学意义(均P>0.05)。对照组患者的营养指标均低于试验组,差异有统计学意义(P<0.05)。两组患者术后并发症发生率分别为15.6%和65.6%,差异有统计学意义(P<0.05);其中试验组呕吐2例,腹泻1例,倾倒综合征1例,反流性食管炎1例,对照组呕吐6例,腹泻5例,倾倒综合征4例,反流性食管炎6例。结论与P型空肠袢食管空肠Roux-en-Y吻合术相比,改良空肠间置代胃术疗效更好,对于患者术后生活质量的提高有一定的帮助,值得临床推广应用。
Objective To evaluate the efficacy of Roux-en-Y anastomosis of Escherichia coli and Esophageal mucosa during gastrointestinal reconstruction. Methods Sixty-four patients with gastric cancer who were admitted from March 2012 to December 2013 were randomly divided into experimental group and control group, with 32 cases in each group. Patients in the control group were treated with Roux-en-Y P-jejunal Roux-en-Y anastomosis, and patients in the test group received modified jejunal interpositional replacement. The evaluation indexes included digestive tract reconstruction time, postoperative eating frequency, changes of nutritional indexes (hemoglobin, albumin, total protein and weight loss) and incidence of complications at 6 months after operation, and the postoperative efficacy of the two groups were evaluated Compare Results There was no significant difference in clinical general characteristics such as age, course of disease and lesion location (P> 0.05). The duration of digestive tract reconstruction was (38.12 ± 12.32) d and (47.92 ± 11.36) days respectively in experimental group and control group. The postoperative eating frequency was 8 times / d and 2 times / d respectively, and the weight loss rate was 10.36 ± 3.31) d and (13.62 ± 5.23) d, respectively, with statistical significance (all P <0.05). The preoperative and postoperative nutritional indices of hemoglobin were (26.4 ± 8.4) g / L and (44.3 ± 13.3) g / L in the test group and (78.6 ± 26.6) g / L and (122.7 ± 39.7) g / L and total protein were (47.2 ± 15.2) g / L and (69.5 ± 21.5) g / L, respectively, with statistical significance (all P <0.05). The preoperative and postoperative hemoglobin values in the control group were (79.4 ± 25.4) g / L and (90.1 ± 29.1) g / L, respectively, and albumin were (25.8 ± 8.8) g / L and (29.6 ± 9.6) g / L , Total protein content (46.9 ± 21.9) g / L and (51.2 ± 16.2) g / L, respectively, with no significant difference (all P> 0.05). The nutritional indexes of the control group patients were lower than the experimental group, the difference was statistically significant (P <0.05). The incidence of postoperative complications in both groups were 15.6% and 65.6%, respectively, with significant difference (P <0.05). Among them, vomiting in 2 cases, diarrhea in 1 case, dumping syndrome in 1 case, reflux esophagitis 1 case, control group vomiting in 6 cases, diarrhea in 5 cases, dumping syndrome in 4 cases, reflux esophagitis in 6 cases. Conclusion Compared with P jejunum Roux-en-Y anastomosis, the improved jejunal interposition gastric bypass is more effective and will be helpful for the improvement of postoperative quality of life. It is worthy of clinical application.